Multidisciplinary Inpatient Rehabilitation Research Articles

Validity of the Chronic Pain Grade Scale in nonspecific chronic low back pain

Higher pain grades are associated with high psychological burden and increase the risk for the persistence of chronic low back pain (CLBP). Previous results on the criterion validity of the Chronic Pain Grade Scale (CPGS) have been extended to the context of inpatient multidisciplinary orthopedic rehabilitation (MOR) and have been supplemented with additional psychosocial and work-related measures. In this multicenter study, psychological, work- and pain-related outcomes were examined among 1010 individuals with nonspecific CLBP (ICD-10: M51/53/54) prior to the beginning of an inpatient MOR stratified by pain grade (I-IV). Additionally, frequency distributions of scores regarding pain-specific self-efficacy, depression, and subjective prognosis of gainful employment by pain grade in patients were investigated. The CPGS differed between all pain grades in the psychological, work- and pain-related outcomes in the expected direction. In post hoc pairwise comparisons, gradeIV was significantly different from the lower grades. Patients with higher pain grades showed unfavorable levels in psychosocial parameters and more frequently scores in the clinical range than expected. These results confirm the criterion validity of the CPGS. The psychosocial risk pattern observed in higher pain grades supports the importance of conducting early pain-related and psychological diagnostic assessments and implementing systematic allocation to needs-based interdisciplinary multimodal treatments.

Multidisciplinary Inpatient Community Rehabilitation Programmes for Frail Older People: A Scoping Review.

The aim of this review was to examine the evidence on multidisciplinary inpatient community rehabilitation intervention programmes for frail older people to establish what frailty rehabilitation programmes if any have been described within the literature and to identify gaps in knowledge and outcome measures used. A scoping review was conducted. Using the Joanna Briggs Institute approach to scoping reviews, a comprehensive literature search was conducted accessing MEDLINE via PubMed, PsychINFO (via Proquest), CINAHL Complete (via EBSCO) and the Cochrane Library and a limited search of the grey literature was undertaken. Four articles met the inclusion criteria. A heterogenous approach to geriatric rehabilitation was evident across the literature. While the reported rehabilitation interventions were aimed at frail older people, the predominant focus of frailty rehabilitation programmes were on the physical functionality of the older person with an absence or limited measurement of any psychosocial, cognitive or spiritual outcomes or aspects of quality of life. This scoping review exposed the paucity of scientific evidence supporting the need for inpatient multidisciplinary rehabilitative programmes for frail older people wishing to remain at home. Timely access to inpatient integrated frailty rehabilitation programmes can improve the quality of life and reduce the likelihood of hospital admissions for frail older people who wish to remain living in their own homes. With the current dearth of published evidence available, there is a necessity to undertake further research to understand the form, content and best models of delivery for frailty rehabilitative services for clinical, policy and practice purposes. There was no patient or public contribution.

Telecoaching of Individuals With Multiple Sclerosis After Inpatient Multidisciplinary Rehabilitation: The Danish MS Hospitals Rehabilitation Study.

Inpatient rehabilitation improves health-related quality of life (HRQOL) for people with multiple sclerosis (MS). However, the obtained improvements decline once people return home. The challenge is to find ways to preserve the beneficial effects for the long term. We investigated whether monthly telecoaching after discharge would enhance the long-term carryover of improvements. We conducted a 1-year exploratory study with 2 delivery methods: telephone coaching and web-based coaching. After discharge, the telephone group received monthly calls; the web-based group responded to monthly online coaching questions. Based on their rehabilitation goals, we put patients into a neuropsychological group or a physical group. In addition, we matched each patient with similar wait-list control patients and treatment patients from the main study. The primary outcome was HRQOL measured by the Functional Assessment in Multiple Sclerosis (FAMS). The neuropsychological group had long-term preservation of HRQOL with both delivery methods, with telephone coaching seeming to be superior. Mean differences in FAMS at the 12-month median follow-up for the neuropsychological group compared with the control wait-list control group were for the telephone group: + 15.4 (95% CI, 3.5-27.4; P = .011); for the web-based group: + 10.9 (95% CI, -3.3 to 25.2; P = .130); for the control treatment group: + 6.9 (95% CI, 0.6-13.3; P = .031). The physical group saw no beneficial effects from telecoaching. Following inpatient multidisciplinary rehabilitation, monthly telecoaching of individuals with MS with neuropsychological challenges enhanced the long-term carryover of HRQOL, with one-on-one telephone coaching showing more pronounced improvements than web-based automated coaching.

Predictors of six-month change in health-related quality of life in people with multiple sclerosis: A secondary data analysis of a randomized controlled trial

BackgroundSymptomatic treatment in people with multiple sclerosis (pwMS) requires multidisciplinary rehabilitation to alleviate disease progression and increasing health-related quality of life (HRQoL). However, the participant- and disease-specific factors that predict sustained improvement in HRQoL in pwMS undergoing inpatient rehabilitation remain unclear. Identifying these factors can help individually tailor inpatient rehabilitation programmes. Therefore, the aim of this study was to identify factors of pwMS at clinic entry for a three-week multidisciplinary inpatient rehabilitation that predict the change in physical and mental HRQoL over six months. MethodsThis is a secondary data analysis of a randomized controlled trial (NCT04356248) conducted at the Valens Rehabilitation Centre, Switzerland. HRQoL was assessed with the Medical Outcome Study 36-item Short Form Health Survey (SF-36) at clinic entry (T0; baseline) and six months after (T3; six-month follow-up). Data for 99 pwMS (mean age in years: 49.60 ± 10.17 SD, mean Expanded Disability Status Scale (EDSS) score: 4.62 ± 1.33 SD, 68.7 % female) were analysed using multiple linear regression. Outcome variables were six-month change in SF-36 Physical (ΔPCS) and Mental Component Scale (ΔMCS) scores. Predictor variables included baseline scores of PCS or MCS, fatigue, anxiety, depressive mood, cardiorespiratory fitness (V̇O2peak/kg), self-efficacy, smoking status, education level, age, EDSS, sex, time since diagnosis and MS phenotype. ResultsThe regression model with ΔPCS as outcome variable explained 18.6 % of the variance of the ΔPCS score (p = .003). Lower PCS score (p < .001) and lower depressive mood (p = .032) at baseline predicted higher ΔPCS score. The regression model with ΔMCS as outcome variable explained 26.8 % of the variance of the ΔMCS score (p < .001). Lower MCS score (p < .001) and longer time since diagnosis (p = .048) at baseline predicted higher ΔMCS score. ConclusionPwMS with lower physical HRQoL and better mood at clinic entry improved most in physical HRQoL over six months. PwMS with lower mental HRQoL and longer time since diagnosis at clinic entry improved most in mental HRQoL over six months. The results of this study contribute to the development of individualized rehabilitation programmes with the aim of maintaining and/or improving HRQoL of pwMS beyond the inpatient rehabilitation stay.

Effects of multidisciplinary inpatient rehabilitation on everyday life physical activity and gait in patients with multiple sclerosis

BackgroundMultiple sclerosis is a progressive neurological disease that affects the central nervous system, resulting in various symptoms. Among these, impaired mobility and fatigue stand out as the most prevalent. The progressive worsening of symptoms adversely alters quality of life, social interactions and participation in activities of daily living. The main objective of this study is to bring new insights into the impact of a multidisciplinary inpatient rehabilitation on supervised walking tests, physical activity (PA) behavior and everyday gait patterns.MethodsA total of 52 patients, diagnosed with multiple sclerosis, were evaluated before and after 3 weeks of inpatient rehabilitation. Each measurement period consisted of clinical assessments and 7 days home monitoring using foot-mounted sensors. In addition, we considered two subgroups based on the Expanded Disability Status Scale (EDSS) scores: ‘mild’ (EDSS < 5) and ‘severe’ (EDSS ≥ 5) disability levels.ResultsSignificant improvements in fatigue, quality of life and perceived mobility were reported. In addition, walking capacity, as assessed by the 10-m walking test, two-minute walk test and timed-up-and-go test, improved significantly after rehabilitation. Regarding the home assessment, mildly disabled patients significantly increased their locomotion per day and complexity of daily PA pattern after rehabilitation, while severely disabled patients did not significantly change. There were distinct and significant differences in gait metrics (i.e., gait speed, stride length, cadence) between mildly and severely disabled patients, but the statistical models did not show a significant overall rehabilitation effect on these gait metrics.ConclusionInpatient rehabilitation showed beneficial effects on self-reported mobility, self-rated health questionnaires, and walking capacity in both mildly and severely disabled patients. However, these improvements do not necessarily translate to home performance in severely disabled patients, or only marginally in mildly disabled patients. Motivational and behavioral factors should also be considered and incorporated into treatment strategies.

The Effectiveness of Inpatient Rehabilitation in Parkinson's Disease: A Systematic Review of Recent Studies.

Parkinson's disease (PD) is a progressive disease, which is associated with the loss of activities of daily living independency. Several rehabilitation options have been studied during the last years, to improve mobility and independency. This systematic review will focus on inpatient multidisciplinary rehabilitation (MR) in people with Parkinson's disease (PwPD), based on recent studies from 2020 onwards. Search strategy in three databases included: multidisciplinary rehabilitation, Parkinson's Disease, inpatient rehabilitation, motor-, functional- and cognitive performance, cost-effectiveness, Quality of Life, and medication changes/Levodopa equivalent daily doses. Twenty-two studies were included, consisting of 13 studies dealing with inpatient MR and 9 studies on inpatient non-MR interventions. Inpatient PD multidisciplinary rehabilitation proved to be effective, as well as non-MR rehabilitation. This review confirms the efficacy of inpatient MR and non-MR in PD, but is skeptical about the past and current study designs. New study designs, including new physical training methods, more attention to medication and costs, new biomarkers, artificial intelligence, and the use of wearables, will hopefully change rehabilitation trials in PwPD in the future.

Relationship between independence in activities of daily living at discharge and physical activity at admission of older postoperative hip fracture rehabilitation inpatients: A retrospective case-control study.

Hip fractures are associated with a reduction in activities of daily living (ADL) and require long-term care. The physical activity of patients with hip fractures is temporarily impaired immediately after surgery, causing difficulty in the measurement of physical activities at the time of rehabilitation admission. This study examined the relationship between ADL at discharge and light- and moderate-intensity physical activity at the time of rehabilitation admission by determining a cut-off value predicting ADL independence. This retrospective case control study analyzed 43 postoperative hip fracture patients aged ≥65years admitting into inpatient rehabilitation. ADL at discharge was assessed using the Functional Independent Measure motor items (FIM-m). The duration of physical activity at the time of rehabilitation admission was measured using an activity tracker equipped with an accelerometer. Prehospital frailty was evaluated using Clinical Frailty Scale. The relationship between these variables was examined using Spearman's product-moment correlation coefficient. Differences in physical activity between patients requiring and not requiring assistance with ADLs were examined using the analysis of covariance. A receiver operating characteristic curve of the need for ADL assistance at discharge was constructed from the duration of physical activity. The duration of physical activity at the time of rehabilitation admission was related to FIM-m at discharge. The cut-off value of the duration of physical activity for predicting the need for ADL assistance at discharge was 135s, with a sensitivity of 83.3% and specificity of 68.4% (area under the curve: 0.76). The duration of physical activity at the time of rehabilitation admission may be a factor that can quantitatively predict the risk of requiring assistance with ADLs at discharge in older hip fracture patients. The duration of light-and-moderate intensity physical activity may be a component of multidisciplinary inpatient rehabilitation to improve patients' ADL.

Short-term effects of a multidisciplinary inpatient intensive rehabilitation treatment on body image in anorexia nervosa

BackgroundPositive changes in weight gain and eating pathology were reported after inpatient treatments for anorexia nervosa (AN). However, changes in the physical body do not always mirror changes in the imagined body. Here, the effect of a treatment focused on body image (BI) was described.MethodsThis retrospective observational study had a quasi-experimental pre-post design without the control group. During the treatment, participants (N = 72) undertake a variety of activities focused on BI. The main outcome was tested through the Body Uneasiness Test.ResultsAt the end of the treatment, BI uneasiness decreased with a significant increase in weight gain.ConclusionThis study highlights the positive short-term effect of a multidisciplinary inpatient intensive rehabilitation treatment on BI in AN. We encourage to design of psychological treatments focusing on the cognitive and emotional bodily representation (i.e. the body in the mind) to increase physical well-being.

134 Evaluation of the Community Rehabilitation Inpatient Specialist Program (CRISP)—an advanced nurse practitioner (RANP)-led program for frail older adults

Abstract Background Frail older adults disproportionately access acute healthcare services. Novel integrated care programs are needed to redesign care delivery focusing on community-based health promotion, as opposed to crisis response. CRISP is a bespoke, RANP-led program that provides direct access for community-dwelling older adults to short-term (2-weeks) in-patient intensive multidisciplinary rehabilitation based on a Comprehensive Geriatric Assessment. Referrals are received from Geriatric ED services, geriatric/neurology/rehabilitation medicine outpatient clinics, ICPOP and local GPs. Admission to a Model 2 Age- Related rehabilitation centre occurs within 4–8 weeks of referral. Methods This Prospective cohort study examines the short to medium-term effects of the CRISP program. Functional, mobility and Quality-of-Life (QoL) measures were collected on admission and discharge. Fall rates, QoL and carer stress are measured four months after completion of the program. Data were analysed using Microsoft Excel. Functional outcome and QoL measurements were compared using paired t-test. Results 73 patients (78%) completed the program and attended for follow up (2021–2022), average age: 80.9 yrs, SD-6.6 yrs, frailty index 5.6 (mild to moderate frailty). There have been statistically significant gains made in performance in activities of daily living (Barthel Index; 76.7A vs 83.9 DC) (p &amp;lt; 0.001), balance (Berg Balance Scale:29.6A vs 36.3 DC) (p &amp;lt; 0.001 and QOL (EQ5D:45.2 A vs 69.8 DC) (p &amp;lt; 0.001). CRISP delivers long-term positive benefits including reduction in falls rates: 2.9(4 months pre-admission) vs 0.5 (4 months following completion of the program) (p &amp;lt; 0.001) and improvement in self-reported QoL, EQ5D:45.2 A vs 62.6 at 4 months following completion of the program. Carers who reported stress 62% (n-45), 91% reported a reduction in stress levels 4 months following the program. Conclusion CRISP provides early intervention at the lowest level of care complexity resulting in reduced fall rates and consequent crisis presentations to acute care. CRISP improves mobility and function promoting independence and improving QoL for community dwelling older adults.

Vitamin D Receptor Gene Polymorphism Predicts the Outcome of Multidisciplinary Rehabilitation in Multiple Sclerosis Patients.

Better knowledge about the possible role of genetic factors in modulating the response to multiple sclerosis (MS) treatment, including rehabilitation, known to promote neural plasticity, could improve the standard of care for this disease. Vitamin D receptor (VDR) gene polymorphisms are associated with MS risk, probably because of the role played by vitamin D in regulating inflammatory and reparative processes. The aim of this study was to evaluate the association of the most important functional VDR SNPs (TaqI (T/C), ApaI (A/C), and FokI (C/T)) with functional outcome in MS patients undergoing multidisciplinary inpatient rehabilitation (MDR) treatment, in order to determine whether genetic profiling might be useful to identify subjects with a higher chance of recovery. To this end, 249 MS inpatients with a diagnosis of either progressive (pMS; n = 155) or relapsing remitting (RRMS; n = 94) disease who underwent MDR treatment (average duration = 5.1 weeks) were genotyped for VDR SNPs by real-time allelic discrimination. The rehabilitation outcome was assessed using the modified Barthel Index (mBI), Expanded Disability Status Scale (EDSS), and pain numerical rating scores (NRS) at the beginning and the end of MDR treatment. A positive correlation was observed in RRMS patients between the VDR TaqI major allele (TT) and mBI increase (i.e., better functional recovery), as assessed by the linear and logistic regression analysis adjusted for gender, age, disease duration, time of hospitalization, HLA-DRB1*15.01 positivity, and number of rehabilitative interventions (Beta = 6.35; p = 0.0002). The VDR-1 TaqI, ApaI, FokI: TCC haplotype was also associated with mBI increase in RRMS patients (Beta = 3.24; p = 0.007), whereas the VDR-2: CAC haplotype was correlated with a lower mBI increase (Beta = -2.18 p = 0.04) compared with the other haplotypes. VDR TaqI major allele (TT), as well as the VDR-1 TaqI, ApaI, FokI: TCC haplotype could be associated with a better rehabilitation outcome in RRMS patients.

Multidisciplinary inpatient rehabilitation for older adults with COVID-19: a systematic review and meta-analysis of clinical and process outcomes

BackgroundOlder adults are at increased risk for disease severity and poorer prognosis following COVID-19 infection. The aim of this systematic review and meta-analysis is to explore the impact of multidisciplinary rehabilitation in the acute or post-acute hospital setting for older adults with COVID-19.MethodsThe Cochrane library, EMBASE, Cinahl and Medline (via EBSCO), PubMed, and Web of Science were systematically searched in June 2022 and a repeat search was completed in March 2023. Screening, data extraction and quality appraisal were conducted independently by two reviewers. Studies reporting outcomes for older adults following multidisciplinary rehabilitation (provided by two or more Health and Social Care Professionals) were included. Both observational and experimental study designs were included. The primary outcome was functional ability. Secondary outcomes included discharge disposition, acute hospital and rehabilitation unit length of stay, mortality, primary and secondary healthcare utilisation, and long-term effects of COVID-19.ResultsTwelve studies met the inclusion criteria, comprising a total of 570 older adults. Where reported, older adults stayed in the acute hospital for a mean of 18 days (95%CI, 13.35- 23.13 days) and in rehabilitation units for 19 days (95%CI, 15.88–21.79 days). There was a significant improvement in functional ability among older adults with COVID-19 who received multidisciplinary rehabilitation (REM, SMD = 1.46, 95% CI 0.94 to 1.98). The proportion of older adults who were discharged directly home following rehabilitation ranged from 62 to 97%. Two studies reported a 2% inpatient mortality rate of older persons during rehabilitative care. No study followed up patients after the point of discharge and no study reported on long term effects of COVID-19.ConclusionsMultidisciplinary rehabilitation may result in improved functional outcomes on discharge from rehabilitation units/centres for older adults with COVID-19. Findings also highlight the need for further research into the long-term effect of rehabilitation for older adults following COVID-19. Future research should comprehensively describe multidisciplinary rehabilitation in terms of disciplines involved and the intervention provided.

Effects of Inpatient Rehabilitation in Leg Lymphedema: A Naturalistic Prospective Cohort Study With Intra-individual Control of Effects

ObjectiveTo quantify therapy-attributable effects of a comprehensive inpatient rehabilitation program for lower limb lymphedema (LLL) and to compare the levels of health-related quality of life (HRQL) to population-based norms. DesignNaturalistic prospective cohort study with intra-individual control of effects. SettingRehabilitation hospital. ParticipantsPatients with LLL (N=67; 46 women). InterventionsComprehensive, multidisciplinary inpatient rehabilitation with 45-60 hours of therapy. Main Outcome MeasuresShort Form 36 (SF-36) for HRQL, lymphedema-specific Freiburg Quality of Life Assessment for lymphatic disorders, Short Version (FLQA-lk), knee-specific Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), and Symptom Checklist-90Standard (SCL-90S). Observed pre/post rehabilitation effects were individually corrected by subtracting the home waiting-time effects and expressed as standardized effect sizes (ESs) and standardized response means (SRMs). Score differences to norms were quantified by standardized mean differences (SMDs). ResultsParticipants were on average aged 60.5 years, not yet obese, and had 3 comorbidities (n=67). The greatest improvement was in HRQL on the FLQA-lk with ES=0.767/SRM=0.718, followed by improvements in pain and function with ES/SRM=0.430-0.495 on the SF-36, FLQA-lk, and KOS-ADL (all P<.001). Vitality, mental health, emotional well-being, and interpersonal sensitivity improved most by ES/SRM=0.341-0.456 on all 4 measures (all P≤.003). Post rehabilitation scores were significantly higher than population norms on SF-36 bodily pain (SMD=1.140), vitality (SMD=0.886), mental health (SMD=0.815), and general health (SMD=0.444) (all P<.001), and comparable on the other scales. ConclusionsThose affected by LLL stages II and III benefited substantially from the intervention, attaining equal or higher levels of HRQL than expected compared with the general population norms. Multidisciplinary, inpatient rehabilitation should be recommended for LLL management.

Nutritional Support During Long COVID: A Systematic Scoping Review.

Introduction: Long COVID is a term that encompasses a range of signs, symptoms, and sequalae that continue or develop after an acute COVID-19 infection. The lack of early recognition of the condition contributed to delays in identifying factors that may contribute toward its development and prevention. The aim of this study was to scope the available literature to identify potential nutritional interventions to support people with symptoms associated with long COVID. Methods: This study was designed as a systematic scoping review of the literature (registration PROSPERO CRD42022306051). Studies with participants aged 18 years or older, with long COVID and who underwent a nutritional intervention were included in the review. Results: A total of 285 citations were initially identified, with five papers eligible for inclusion: two were pilot studies of nutritional supplements in the community, and three were nutritional interventions as part of inpatient or outpatient multidisciplinary rehabilitation programs. There were two broad categories of interventions: those that focused on compositions of nutrients (including micronutrients such as vitamin and mineral supplements) and those that were incorporated as part of multidisciplinary rehabilitation programs. Nutrients included in more than one study were multiple B group vitamins, vitamin C, vitamin D, and acetyl-l-carnitine. Discussion: Two studies trialed nutritional supplements for long COVID in community samples. Although these initial reports were positive, they are based on poorly designed studies and therefore cannot provide conclusive evidence. Nutritional rehabilitation was an important aspect of recovery from severe inflammation, malnutrition, and sarcopenia in hospital rehabilitation programs. Current gaps in the literature include a potential role for anti-inflammatory nutrients such as the omega 3 fatty acids, which are currently undergoing clinical trials, glutathione-boosting treatments such as N-acetylcysteine, alpha-lipoic acid, or liposomal glutathione in long COVID, and a possible adjunctive role for anti-inflammatory dietary interventions. This review provides preliminary evidence that nutritional interventions may be an important part of a rehabilitation program for people with severe long COVID symptomatology, including severe inflammation, malnutrition, and sarcopenia. For those in the general population with long COVID symptoms, the role of specific nutrients has not yet been studied well enough to recommend any particular nutrient or dietary intervention as a treatment or adjunctive treatment. Clinical trials of single nutrients are currently being conducted, and future systematic reviews could focus on single nutrient or dietary interventions to identify their nuanced mechanisms of action. Further clinical studies incorporating complex nutritional interventions are also warranted to strengthen the evidence base for using nutrition as a useful adjunctive treatment for people living with long COVID.

Combined multidisciplinary in/outpatient rehabilitation delays definite nursing home admission in advanced Parkinson's disease patients.

Advanced Parkinson's disease (aPD) patients have a high risk on definite nursing home admission. We analyzed the effectiveness of an in-and outpatient multidisciplinary rehabilitation, focusing on activities of daily living (ADL) and delaying definite nursing home admission. This study included 24 aPD patients, who received a 6-week inpatient multidisciplinary rehabilitation program, including optimization of pharmacotherapy, which was followed by an individualized outpatient support program during 2 years (intervention group). A non-randomized matched control group (n = 19), received care as usual. Primary endpoints consisted of the Amsterdam Linear Disability Scale (ALDS) and percentage of patients being able to live independently at home after 2 years. Secondary endpoints included changes in medication (LEDD), motor performance (SCOPA-SPES), cognition (SCOPA-COG), hallucinations (NPI) and depression (BDI). Overall, 83% of patients were able to return home after the 6-week inpatient intervention, and 65% still lived at home at 2 years follow-up. Median ALDS scores after 2 years in the intervention group were significantly better, compared to the control group (p = 0.002). All secondary endpoints had improved significantly vs. baseline directly after the 6-week inpatient rehabilitation, which had disappeared at 2 years follow-up, with the exception of the daily dose of medication, which was significantly higher in the intervention group. This 2-year follow-up study showed that a combined multidisciplinary in/outpatient rehabilitation program for aPD patients, was able to stabilize ADL functions, and finally delayed definite nursing home admissions in 65% of treated patients. filenumber M10.091051; ABR code NL32699.042.10.

The Patient’s Physiological Status at the Start Determines the Success of the Inpatient Cardiovascular Rehabilitation Program

Multidisciplinary inpatient rehabilitation plays an important role in the recovery of patients with cardiovascular diseases (CVDs). Lifestyle changes, achieved by exercise, diet, weight loss and patient education programs, are the first steps to a healthier life. Advanced glycation end products (AGEs) and their receptor (RAGE) are known to be involved in CVDs. Clarification on whether initial AGE levels can influence the rehabilitation outcome is important. Serum samples were collected at the beginning and end of the inpatient rehabilitation stay and analyzed for parameters: lipid metabolism, glucose status, oxidative stress, inflammation and AGE/RAGE-axis. As result, a 5% increase in the soluble isoform RAGE (sRAGE) (T0: 891.82 ± 44.97 pg/mL, T1: 937.17 ± 43.29 pg/mL) accompanied by a 7% decrease in AGEs (T0: 10.93 ± 0.65 µg/mL, T1: 10.21 ± 0.61 µg/mL) was shown. Depending on the initial AGE level, a significant reduction of 12.2% of the AGE activity (quotient AGE/sRAGE) was observed. We found that almost all measured factors improved. Summarizing, CVD-specific multidisciplinary rehabilitation positively influences disease-associated parameters, and thus provides an optimal starting point for subsequent disease-modifying lifestyle changes. Considering our observations, the initial physiological situations of patients at the beginning of their rehabilitation stay seem to play a decisive role regarding the assessment of rehabilitation success.

The Feasibility of Web-Based Working Memory Training in Patients With Cancer Attending Inpatient Rehabilitation.

Cognitive complaints are common late effects in patients with cancer, and no standard treatment exists. Recent studies with several patient populations have indicated that there is potential to improve working memory (WM) via web-based WM training. However, the feasibility of including web-based WM training as part of inpatient cancer rehabilitation, in combination with unprompted home-based training, has not been studied. The aim of this study was to assess the feasibility of including web-based WM training (using Cogmed QM) during inpatient rehabilitation and its subsequent unprompted completion in a home-based setting. Patients with cancer who self-reported cognitive complaints were instructed to complete 25 Cogmed QM sessions during their 3-week inpatient multidisciplinary cancer rehabilitation and subsequently at home after discharge from rehabilitation. The feasibility was determined by assessing the study recruitment, adherence to the WM training, improvements in training tasks (compliance measure) and patient experiences by individual interviews. Twenty-nine (27 women) of 32 eligible patients (89.6%) started WM training, 1 declined participation and 2 patients withdrew before WM training started. Twenty-six of 29 (89.6%) participants adhered to the intervention during rehabilitation, while 19 of 29 (65.5%) also adhered to the subsequent unprompted home-based intervention. All participants who completed the Cogmed QM sessions demonstrated improvements in the training tasks, as defined by the Cogmed Improvement Index (MD = 24.05, SD = 9.38, range 2-44, P < .011). Interview data suggested that practical limitations, including a lack of time, technical difficulties, difficulties finding a suitable disturbance-free environment and low motivation were barriers to completing the training at home. The findings show that it is feasible to include web-based WM training during inpatient multidisciplinary rehabilitation for adult patients with cancer with cognitive complaints. However, patient adherence to unprompted web-based WM training after discharge from rehabilitation was not optimal. Thus, future studies should consider the barriers to adherence and the need for supervision and social support to reinforce home-based training.

Large Improvements in Health-Related Quality of Life and Physical Fitness during Multidisciplinary Inpatient Rehabilitation for Pediatric Cancer Survivors.

Simple SummaryAfter cancer treatment, children often suffer from various health problems. Rehabilitation can improve their quality of life. We present data for 236 children and 478 parents who filled out questionnaires before and after inpatient rehabilitation. In our sample, both children and parents reported that the quality of life of the children had substantially improved during rehabilitation, especially their physical and psychosocial quality of life. Children also improved in physical exercises and their functional status. Parents and children showed better agreement regarding the child’s health status after rehabilitation than before. A specific method of statistical analysis (performance score) helped to reduce disagreement between parents and children. We therefore conclude that inpatient rehabilitation is effective for children after cancer treatment and that the performance score should be used in research on rehabilitation for children after cancer treatment to have the most accurate results.Rehabilitation is a key element in improving health-related quality of life (HRQOL) for pediatric cancer survivors. The aim of this study was to present data from a multidisciplinary inpatient rehabilitation treatment. Children took part in a four-week multidisciplinary family-oriented inpatient rehabilitation. A total of 236 children (>5–21 years) and 478 parents routinely completed electronic patient-reported outcomes (ePROs), performance-based assessments, and clinician-rated assessments before (T1) and at the end (T2) of rehabilitation. HRQOL was assessed with the PedsQL generic core and PedsQL cancer module. Data were analyzed using repeated measures analysis of variance (ANOVA). Statistically significant improvements with medium to large effect sizes were observed for most HRQOL scales (η2 = 0.09–0.31), as well as performance-based and clinician-rated assessments for physical activity and functional status (η2 > 0.28). Agreement between children’s PROs and parents’ proxy ratings was lower before (rICC = 0.72) than after (rICC = 0.86) rehabilitation. While the concordance between children and parents’ assessment of changes during rehab was low to moderate (r = 0.19–0.59), the use of the performance score led to substantially increased scores (r = 0.29–0.68). The results of this naturalistic observational study thus highlight the benefits of multidisciplinary pediatric inpatient rehabilitation for childhood cancer survivors. The use of the performance score is recommended in this field.

Factors affecting short-term functional gain following total knee arthroplasty in patients aged from 75 years at a postacute rehabilitation setting.

The intensive rehabilitation of older patients after total knee arthroplasty (TKA) is vital for short-term improvement in mobility and daily living activities. We aimed to investigate the effectiveness of multidisciplinary rehabilitation and assess the early postoperative predictors that are associated with functional gain in TKA patients aged from 75 years in a postacute care setting. This study included 190 patients following primary TKA who were admitted at the postacute rehabilitation hospital. The main outcome measures were the motor component of functional independence measure (M-FIM), M-FIM effectiveness, numerical rating scale, knee extension strength and range of motion, 10-m walk test, Berg balance scale (BBS), and mini-mental state examination (MMSE). The functional gain between patient age groups of ≥75 ( n = 105) and <75 ( n = 85) years were compared. Although patients aged ≥75 years showed lower improvement in BBS score compared with <75 years, the M-FIM gains and other physical functions were similar in both age groups. In multivariate analysis, the results for M-FIM at admission (β: -0.703; P = 0.001), BBS (β: 0.342; P = 0.032) and MMSE (β: 0.446; P = 0.021) were independently associated with functional gain in the patients following TKA aged ≥75 years. Multidisciplinary inpatient rehabilitation was beneficial for basic functional gain except for improvement in balance ability in patients after TKA aged ≥75 years. Functional level, balance ability and cognitive status in the early postoperative period can be useful predictors for short-term functional gain in the postacute care phase.

The subjective minimal important change for the Six Spot Step Test in people with multiple sclerosis- The Danish MS Hospitals Rehabilitation study.

The Six Spot Step Test has shown good psychometric properties in terms of validity and reliability in people with multiple sclerosis. Yet, the responsiveness and minimal important change are unknown. The objective was to investigate the responsiveness of the Six Spot Step Test against the perceived change of walking limitations and establish estimates for the minimal important change in people with multiple sclerosis. The Six Spot Step Test was performed before and after four weeks of specialised multidisciplinary inpatient rehabilitation by 142 adults with mild to severe multiple sclerosis. Responsiveness was determined based on anchor- and distribution-based methods, using the Multiple Sclerosis Walking Scale-12 as external criterion. In a supplementary analysis, the Six-Minute Walking Test was used as an external criterion. The correlation between the baseline (r = 0.56, p < 0.01) and discharge (r = 0.55, p < 0.01) Multiple Sclerosis Walking Scale-12 and Six Spot Step Test scores were acceptable. Furthermore, the change scores were weakly associated (r = 0.1, p = 0.27). This trend was similar for the Six-Minute Walking Test when used as anchor. The smallest detectable change was estimated to 1.7seconds. An improvement in the Six Spot Step Test exceeding 2.1 (95% CI -0.9 to 5.0) sec and 4.9 (95% CI 1.2-8.6) sec may be considered clinically important on a group level based on the Multiple Sclerosis Walking Scale-12 and the Six-Minute Walking Test, respectively. In a sample of mild to severely disabled people with multiple sclerosis, the Six Spot Step Test showed fair responsiveness against a subjective and objective criterion, indicating a minimal important change between ≥ 2.1 and ≥ 4.9seconds, respectively. However, a weak association between the change in the Six Spot Step Test and the subjective and objective external criterion calls for cautious interpretation. Hence, the results should be further verified against a valid external criterion.

Development of an inpatient rehabilitation pathway for motor functional neurological disorders: Initial reflections.

Emerging research supports a primary role for rehabilitation therapy alongside psychoeducation and psychotherapy in the treatment of functional neurological disorder (FND). While consensus recommendations for physical therapists, occupational therapists, and speech and language pathologists treating FND have been published, specific recommendations for multidisciplinary FND care delivered on an inpatient rehabilitation unit are yet to be established. This report describes one inpatient rehabilitation facility's efforts to design and implement a clinical pathway for patients with acute-onset motor FND-patients recently hospitalized for work-up of new neurological symptoms subsequently deemed functional. Detailed descriptions on defining admission criteria and delivering consensus- and evidence-based multidisciplinary inpatient rehabilitation are provided. In the context of prospective research studies, considerably more work is needed to delineate the optimal duration and intensity of inpatient rehabilitation treatment for the management of patients with motor FND.